About PharmaCare Special Authority

PharmaCare Special Authority grants full benefit status to a drug, medical supply or medical device that otherwise would not be covered or only partially covered. Coverage is provided for patients with specific medical circumstances and the actual reimbursement depends on the patient’s PharmaCare plan rules, including any annual deductible requirements.

To receive coverage, Special Authority approval must be in place before the patient purchases the prescription. Coverage cannot be provided retroactively.

Special Authority approval may be granted for:

Drug Type

Description

More Information

Limited Coverage drugs

Medications that generally are not considered to be first-line therapies or that have more cost-effective alternatives.

See list below to access the criteria and forms for these drugs.

Non-reference (partially covered) drugs

For patients who experience an adverse reaction or treatment failure on the reference drug.

See list below to access the criteria and forms for these Reference Drug Program drugs.

Alternate products

For patients unable to use the low cost alternative drug due to an allergy.

The list below includes all drugs that require Special Authority approval. Special Authority is also required for Insulin Pumps.

To access the criteria for Special Authority coverage and form(s) for each drug, click on the drug name. To access a description of the reimbursement category under which the drug is covered, click on the category name.

This table can be sorted by brand or generic name or Special Authority Category.

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